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There have been major advances in the treatment of cirrhosis in the past few decades. In particular, it has become easier to recognize, prevent and treat complications of cirrhosis. People with cirrhosis should see their health care provider regularly for monitoring and treatment of cirrhosis complications. Although cirrhosis cannot be cured, several treatments are available to minimize cirrhosis-related complications. Other treatments are recommended to help prevent complications.

Avoid Substances that Can Injure the Liver People with cirrhosis should avoid consuming substances that can further damage the liver. The most common of these is alcohol. You should talk to your health care provider before taking any new medications (including prescription and non-prescription drugs, herbs, vitamins or dietary supplements). Acetaminophen (Tylenol®) is a nonprescription medication that can further injure the liver in people with cirrhosis. The exact amount of acetaminophen that is safe in cirrhosis is uncertain; some experts recommend that patients not use more than 650 mg per dose every 4 to 6 hours, with no more than 2,000 mg per day. However, even low doses may not be safe for those who drink alcohol. Use of acetaminophen should always be discussed with a health care provider.

Consider Liver Transplantation Not all patients with cirrhosis will require a liver transplant. Many may not be eligible for one. However, because the waiting list for liver transplantation is lengthy (up to two years in some regions), it is important to know if liver transplantation is a reasonable option while you are still relatively healthy. See the "Liver Transplantation" section for more details.

Dietary Advice People with advanced cirrhosis may require a specialized diet that includes lower amounts of salt. Salt restriction is usually recommended for people with early cirrhosis who tend to accumulate fluid. Many people with liver disease also have diabetes, controlling your intake of carbohydrates is very important and can be harder with liver disease. A controlled proteindiet should be used to help control encephalopathy, with the use of lactulose to remove toxins from the body. A health care provider or dietitian can help to determine if dietary changes are needed.

Exercise Exercise is generally safe for people without advanced stage cirrhosis. Exercise may increase the risk of variceal bleeding in patients with advanced disease (such as those who have ascites or varices). Thus, check with your health care provider regarding the risks and benefits of exercise. Remember, you want to fight the effects of muscle mass loss that is often present for cirrhosis patients.

Get Vaccinations People with cirrhosis should be vaccinated against hepatitis A and B. Pneumococcal vaccine and yearly influenza vaccine are also recommended. Care should be taken to only receive "inactive" vaccinations—live virus vaccinations should not be administered.

Screen For & Treat Varices People with cirrhosis should undergo an upper endoscopy to determine if varices are present in the esophagus, the tube that connects the mouth and stomach. Varices develop when blood cannot flow easily through the liver. Blood backs up in blood vessels, causing them to stretch. The vessel walls become thin and could break under pressure. If you have bloody or black, tarry stools or are vomiting bright red blood or a black substance that looks like coffee grounds, you are experiencing a bleed and need help immediately. Go to your local ER or call 911. Treatment: routine EGD (endoscopy) and banding (rubber bands are used to “tie off” any varices). You will be screened for potential bleeds and you might be banded periodically to prevent them.

Screen For Ascites & Edema Ascites and edema can lead to complications, particularly infection. Ascites can also cause a person to feel short of breath or full. Treatment is usually recommended to reduce the amount of fluid that collects in the lower legs and abdomen. Treatment usually involves taking one or more diuretic pills (water or fluid pills) and following a low sodium (salt) diet and, if that fails, paracentesis is done.

Screen for Hepatic Encephalopathy (HE) People with cirrhosis can develop confusion, which is sometimes subtle. Detecting confusion is important since treatment is available and the confusion itself can lead to serious problems (e.g., an automobile accident). A change in the sleep pattern (insomnia or sleeping too much) may be an early sign. Symptoms of this condition include behavior and personality changes, fatigue, drowsiness, slurred speech, confusion, disorientation and muscle twitching. In the last stage of hepatic encephalopathy, seizures, coma and death occur. A good way to measure for HE is to use a journal that you can use to track your use of lactulose, number of bowel movements and a test of mental and small muscle acuity, which consists of recording your signature and a five-point star (don't lift the pen or pencil from the paper type). Have someone help you by reviewing the journal, particularly any changes to your signature or the star!

Screen for HepatoCellular Carcinoma (HCC) People with cirrhosis should have tests to detect hepatocellular carcinoma (cancer of the liver). Testing usually requires an ultrasound examination of the liver and a blood test every 6 to 12 months.

Use Prescribed MedicinesAlways,always, always follow the drug regimen that is prescribed by your doctors! There is method to what the doctors are trying to accomplish with the prescriptions. If you have multiple doctors, make sure they all coordinate prescriptions and have your hepatologist review any new prescriptions to make sure they are consistent with your treatment. For instance: Inderal (Propranolol or Nadolol) is often prescribed to lower the pressure in swollen veins. Sometimes nitrates are added to these medicines to help relieve pressure. If you are on nitrates, you cannot take Viagra, Cialis or Levitra.

Vitamins & Supplements The benefit of vitamins, antioxidants and other supplements on the underlying liver disease has not been established. Several herbal therapies have been reported as having a benefit in patients with cirrhosis. None has clearly been proven to be effective, although some continue to be studied. Most experts do not recommend herbs or other over the counter supplements for people with cirrhosis.